Suicidal intent in fatal drug overdoses

项目摘要 在过去的二十年里，全国自杀率增长了30%，近46,000人死于自杀。 2020年自杀在同一时期，药物过量死亡率的增长甚至更为显著。 2021年有近10.8万人死于药物过量，创历史新高。物质使用和自杀意念 是紧密相关的这种重叠使得死亡调查人员很难将意图归类为致命药物 吸毒过量因此，许多被裁定为非故意或“未确定”的过量死亡实际上可能是自杀 受害者该项目将利用来自死亡证明、毒理学、警察和验尸官/法医的数据 报告调查法医学死亡调查人员如何在致命的药物过量中对意图进行分类。数据 样本包括一个药物滥用和过量死亡率高的区域的三个国家。与混合 方法的方法，定量和语言分析，该项目将首先确定哪些因素最 意图分类的预测。潜在因素包括死者的特征、死亡调查 系统和社区的社会经济条件。主要数据来源是国家统计局。 暴力死亡报告系统（NVDRS）和国家无意药物过量报告系统 （SUDORS）。这两个来源都包含死者级别的信息。而NVDRS包含故意死亡， 药物中毒（自杀），SUDORS包含非故意（意外）和“未确定”死亡。的 这些来源的组合将提供关于致命药物过量中自杀意图的新见解。的 该项目还将制定一项统计调整，以估计少报的自杀死亡人数。这一调整将 根据药物中毒自杀死亡模型（在NVDRS中）构建，以估计漏报自杀率 意外和“未确定”致命服药过量死亡中的死亡（在SUDORS）。该项目将 帮助确定急需精神卫生保健和治疗的人群。此外，无意 吸毒过量死亡和自杀死亡需要一套不同的预防战略和政策。准确 因此，死亡率监测系统是这两种预防努力的核心。本项目的分析将 告知死亡干预点研究者关于致命性内意图的重要分类的说明 吸毒过量

Project Summary The national suicide rate has grown by 30% over the last twenty years, and nearly 46,000 people died by suicide in 2020. The rate of drug overdose death has grown even more dramatically over the same period. Nearly 108,000 people died by drug overdose in 2021, an all-time high. Substance use and suicidal ideation are strongly correlated. This overlap makes intent difficult for death investigators to classify in fatal drug overdoses. Consequently, many overdose deaths ruled unintentional or “undetermined” may in fact be suicide victims. This project will leverage data from death certificate, toxicology, police, and coroner/medical examiner reports to investigate how medicolegal death investigators classify intent within fatal drug overdoses. The data sample contains three states in a region with high rates of drug abuse and overdose death. With a mixed methods approach of quantitative and linguistic analysis, the project will first identify which factors are most predictive of intent classification. Potential factors include characteristics of decedents, death investigation systems, and the socioeconomic conditions of communities. The principal data sources are the National Violent Death Reporting System (NVDRS) and the State Unintentional Drug Overdose Reporting System (SUDORS). Both sources contain decedent-level information. Whereas NVDRS contains intentional deaths by drug poisoning (suicide), SUDORS contains unintentional (accidental) and “undetermined” deaths. The combination of these sources will provide novel insight on suicidal intent among fatal drug overdoses. The project will also develop a statistical adjustment to estimate underreported suicide deaths. This adjustment will build from a model of suicide deaths by drug poisoning (in NVDRS) to estimate rates of underreported suicide deaths in the unintentional and “undetermined” fatal overdose deaths (in SUDORS). The project will therefore help identify populations in critical need of mental healthcare access and treatment. Furthermore, unintentional drug overdose deaths and suicide deaths require a different set of prevention strategies and policies. Accurate mortality surveillance systems are therefore central to either prevention effort. The analyses in this project will inform points of intervention for death investigator instruction on the important classification of intent within fatal drug overdoses.